Tuesday 19 November 2019

Dr Ruairi Hanley: Junior doctors' hours endanger patient safety

OVER the past month, there has been widespread coverage of the outrageous working hours of our junior doctors, or more correctly, our non-consultant hospital doctors (NCHDs).

Young colleagues have taken to the airwaves to highlight this ongoing scandal and the impact on their lives.

We have been here before. In 1999, I was a final-year medical student at UCD. I recall public protests by NCHDs over this issue. Eventually, the then government agreed that doctors would receive overtime pay, something that had been denied to them for decades.

It was then that hospital administrators suddenly realised how many hours medical professionals were actually working. These dangerous conditions had apparently caused little concern for bureaucrats – until the large pay bills starting landing on their desks.

By the middle of the last decade HSE administrators had slowly realised that overtime for doctors was not optional. Our hospitals often rely on a small number of NCHDs to do 60-70 hours a week, including shifts of 30-36 hours, to maintain the existing levels of care.

This leads to exhaustion and is a clear threat to the health and safety of patients as well as doctors. It also represents an illegal breach of the European Working Time Directive.

The HSE has spent years obsessively focusing on the NCHD pay bill, rather than trying to safely reduce working hours. Such tactics have proved largely unsuccessful.

There are only three ways to solve this crisis. We can hire more NCHDs, cut medical services, or ask other healthcare workers to do more.

The first option is not feasible in the current economic climate. The second would cause widespread patient suffering. The third option, however, has been largely ignored and warrants further consideration.

At least a third of the workload of an NCHD is taken up with non-medical duties, such as transporting documents. This situation is worsened by the 'protocol-led' world of Irish nursing, in which a patient cannot be given a simple, over the counter, paracetamol tablet without hauling a doctor out of bed at 4am to "write it up".

Unfortunately, many non-medical staff members adopt a semi-permanent "work-to-rule" attitude, with mandatory breaks, rigidly inflexible work practices and militant unions eager to pounce on any suggestion of additional productive activity. The HSE has made little effort to confront this intransigence, preferring instead to allow its staff to dump inappropriate tasks onto young doctors.

Meanwhile, despite their incredibly unhealthy working conditions, NCHDs consistently have the lowest absenteeism rate in the public sector. Typically, less than 1pc of doctors are out sick on any given day. In contrast, the average absenteeism rate across the HSE for other staff categories is almost 5pc.

NCHDs are the hardest-working and most committed public servants in the State. If they took even half the number of sick days as nurses, our entire health system would probably collapse in a matter of weeks.

In conclusion, the treatment of NCHDs in our health service is a national scandal that has rumbled on for decades. This is not only grossly unfair to some of the brightest and most dedicated young people in Ireland, but it also puts the lives of patients at risk.

The HSE knows what needs to be done, but it is not prepared to act.

When I qualified in 2000, I never believed that 13 years later this problem would still be ongoing. Those responsible should hang their heads in shame.

Irish Independent

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